Treatment and rehabilitation of traumatized refugees (TR-REFUGEES)

In the scientific community there is a call for more comprehensive studies of the trajectories of health and well-being of traumatized refugees, in terms of the scope of investigated aspects of refugees' health, quality of life, and functioning in exile, the methods used, and the length of follow-up. TR-REFUGEES is a naturalistic and longitudinal, quantitative and qualitative, study of the trajectories of mental health, wellbeing and exile life functioning of 54 traumatized refugees from treatment start, during, and after treatment, of the refugee patients' experience of therapy, and of their therapists' reflections on the treatment processes. Data collection started in 2006 and was terminated in 2017. We are now in a phase of analyzing and writing. The study investigates relationships between these patients’ background and trauma history, and their mental health, personality functioning, attachment history, four areas of quality of life, employment or engagement in formal studies, and their acquisition of the Norwegian language, and the the changes in these variables over time, during and after therapy. The follow-ups at various points in time capture the patients' experience of their treatment process and changes or fluctuations in the patients' social situation, mental health symptoms, and quality of life. Participants have been followed-up for up to 10 years. By now, five published articles, a PhD thesis, and several master degree theses document some of the findings from the study. We will investigate in more detail how subgroups of the former refugee patients have benefitted from the psychological treatment that was offered in mental health specialist services in Norway. The refugee patients received various forms and lengths of psychological therapy in specialist mental health outpatient services and in publicly funded solo practices (“private practices”).

2006 This project is ongoing 2025

Project Manager

Project Members

  • Aims of the study are:

  • To gain increased knowledge of how psychological health, quality of life, and functioning in everyday life in Norway develop over time – before, during, and after mental health treatment in specialist services

  • To gain knowledge about how pre-flight, flight, and post-flight personal history, potentially traumatic experiences, social and cultural factors relate to the participants’ health and well-being in their exile living 

  • To investigate how the patients and the therapists experience the therapeutic process, and what promotes or hinders a beneficial therapeutic process

  • To examine therapeutic processes in search of factors and interventions that relate to a positive treatment outcome

A naturalistic, qualitative and quantitative, longitudinal study.

Approvals: The project was approved by the Regional Ethics Committee REK, by the Data Protection Official, Norwegian Social Science Data Services.

The project is financed by NKVTS. The project has had 1.5 – 1.0 researchers during various periods.


Treatment and rehabilitation of traumatized refugees  (the umbrella project), 2006 – 2025.

– A prospective and naturalistic study of 54 patients with refugee and trauma backgrounds who were recruited consecutively as they were admitted to individual treatment in outpatient clinics or by psychiatrists and psychologists in solo- or ’private’ practices within the psychiatric specialist health care system. Therapy sessions were audio taped in the solo practices, but this turned out not to be feasible in the clinics. The objective with audiotaping was to study some treatment processes more closely.

The project began formal data collection in October 2006, and ended data collection in January 2018. The patients were interviewed up to eight times (each time including one to six interviews) over the course of up to ten years: Upon admission to treatment (T1), one year after our first contact with the patient (T2), three years after our first contact with the patient (T3), whenever treatment was discontinued (Tx), and for many, at additional 2-3 years intervals. At treatment start, we investigated demographics, family relations, personal history, traumatic experiences in childhood, adolescence, and adult years, flight history, experiences of coming to Norway as a refugee, factors pertaining to work and education, and language acquisition in exile. In addition, we assessed personality function, psychological and physical complaints, particularly PTSD, anxiety and depression, social difficulties, resources and interests. Furthermore, the patients and the therapists were interviewed about the treatment process. Questions were also asked about other relevant aspects of the patient’s life, and certain psychometric measurements were repeated. The repeated qualitative interviews and quantitative assessments at follow-ups recorded the changes or fluctuations in the participants’ mental health, well-being, and social situation. Our interviews have comprised 5 to 10 years of the participants’ lives, from treatment start, through treatment of various lengths, and on in life. Publishing from the study is ongoing.

Publications: See Norwegian Version.


Marianne Opaas’ doctoral degree project (Completed April 29., 2016): "Trauma, personality function, and posttraumatic reactions: A retrospective and prospective study of traumatized refugee patients".

Main supervisor: Professor Ellen Hartmann, Institute of Psychology, University of Oslo, Norway.

Assisting supervisor: Sverre Varvin, Dr. Philos., MD, Norwegian Centre for Violence and Traumatic Stress Studies/since fall 2014: Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway (HiOA).

– An investigation of the connection between background factors, personality function, symptoms of mental distress, quality of life, employment, exile language proficiency, and psychological treatment among the traumatized refugee patients of the main/umbrella study. The Rorschach method was central in the investigation of personality function, supplemented by and compared with a number of other investigative methods.


In her thesis, Marianne Opaas and co-authors found that childhood adverse experiences were even more strongly related to their present suffering than more recent experiences of war, persecution and other human rights violations (HRVs). Moreover, we found two new Rorschach components or personality dimensions that characterized the way these individuals functioned under the relative stress of assessment: 1) ‘Trauma Response’, along a continuum from constricted (i.e., restrained or limited associative and emotional activity) to flooded (i.e., traumatic intrusions, emotional regulation problems, and logical breaches in thinking), and 2) ‘Reality Testing’, along a continuum from impaired to adequate perceptual reality testing (i.e., ability to notice ordinary aspects of the environment and perceive events and objects in ways that correspond with realities and the ways others perceive them). Perceptual Reality Testing was more strongly related to the participants’ overall mental health and well-being than the other, more trauma-specific variable.

At the three-year follow-up, the participants’ mean results showed statistically significant improvements in depression, anxiety, PTSD, and quality of life, but the individual variation in outcome was pronounced. At T3 most participants still qualified for a mental health diagnosis. Higher scores on the Reality Testing dimension continued to predict better functioning during follow-up. The problems with reality testing identified in this study were of an apparently trauma-based nature, not to be confused with the reality testing difficulties of psychotic patients.


Marianne Opaas (2016). Trauma, personality function, and posttraumatic reactions: A retrospective and prospective study of traumatized refugees. Dissertation for the degree PhD, Institute of Psychology, University of Oslo. Permanent link to the dissertation:


Mehdi Farsbaf’s doctoral degree project (2012 –  discontinued in 2017): "Healing trauma: Curative processes in psychotherapy with traumatized refugees".

Main supervisor: Sverre Varvin, Dr. Philos., MD, NKVTS, from 2014: HiOA.

Assistant supervisor: Erik Stänicke, Dr. Psychol, Associate Professor, University of Oslo (UiO).

Mehdi Farsbaf’s doctoral project was a prospective naturalistic study of the treatment processes of patients with refugee and traumatized backgrounds undergoing psychodynamically-oriented treatment by psychologists and psychiatrists in publicly funded ‘private practice’. The patients were part of the participants of the umbrella project. The project was terminated without completion in 2017. One publication may be forthcoming.


Opaas, M., Wentzel-Larsen, T., & Varvin, S. (2022). Predictors of the 10 year course of mental health and quality of life for trauma-affected refugees after psychological treatment. European Journal of Psychotraumatology, 13(1). doi:10.1080/20008198.2022.2068910

Opaas, M., & Hartmann, E. J. (2021). Traumatized Refugees in Psychotherapy: Long-Term Changes in Personality, Mental Health, Well-Being, and Exile Life Functioning. Journal of Nervous and Mental Disease. doi:10.1097/NMD.0000000000001396

Sarpong, S. P., & Sarpong, S. P., & Opaas, M. (2021). Forced Migration and the Quest for Normality: Post-Migratory Experiences of Traumatized Iraqi Refugees in Norway. Journal of Refugee Studies, 34(4), 4092-4120. doi:10.1093/jrs/feab024

Gulliksen, S., Hekne, I., Råbu, M., & Opaas, M. (2020). “Når jeg føler meg trygg, prøver jeg å si litt om det jeg har vært utsatt for”. Traumatiserte flyktningers opplevelse av tillit i psykoterapi. Tidsskrift for psykisk helsearbeid, 4, 227-238.

Opaas, M. (2020). Flyktninger med traumerelaterte plager – En kunnskapsoversikt. In A. O. Berg & K. HoltK. Holt (Red.) Kultur og kontekst i praktisk psykologarbeid (pp. 89-120). Gyldendal Norsk Forlag A/S.

Opaas, M., Wentzel-Larsen, T., & Varvin, S. (2020). The 10-year course of mental health, quality of life, and exile life functioning in traumatized refugees from treatment start. PLOS ONE, 15(12), 1-21. doi:10.1371/journal.pone.0244730

Opaas, M. (2019). Med traumer i bagasjen. In R. Dybdahl, L. Lien, H. Siem, H. H. Bakke & I. Julardzija (Red.) Asylsøkere og flyktninger. Psykisk helse og livsmestring (pp. 121-143). Universitetsforlaget.

Opaas, M., Hartmann, E. J., Wentzel-Larsen, T., & Varvin, S. (2016). Relationship of Pretreatment Rorschach Factors to Symptoms, Quality of Life, and Real-Life Functioning in a 3-Year Follow-Up of Traumatized Refugee Patients. Journal of Personality Assessment, 98(3), 247-260. doi:10.1080/00223891.2015.1089247

Opaas, M., & Varvin, S. (2015). Relationships of Childhood Adverse Experiences with Mental Health and Quality of Life at Treatment Start for Adult Refugees Traumatized by Pre-Flight Experiences of War and Human Rights Violations. Journal of Nervous and Mental Disease, 203(9), 684-695. doi:10.1097/NMD.0000000000000330

Opaas, M., & Hartmann, E. J. (2013). Rorschach Assessment of Traumatized Refugees: An Exploratory Factor Analysis. Journal of Personality Assessment, 95(5), 457-470. doi:10.1080/00223891.2013.781030